Insight into ICU nurses' experiences in providing terminal care
At least one in five Americans die while using intensive care service—a number that is expected to increase as society ages. Many of these deaths involve withholding or withdrawing life sustaining therapies. In these situations, the role of intensive care nurses shifts from providing aggressive care to end of life care, whereas traditional goals of critical care center on curative interventions for acutely ill patients. For a number of reasons the transition in care is often not a smooth one. While hospice and palliative care nurses typically receive specialized support to cope with death and dying, intensive care nurses usually do not receive this support. This phenomenological research study explored the experiences of nurses providing terminal care in the ICU.
The purposive sample consisted of 18 registered nurses delivering terminal care in an ICU who participated in semi-structured individual interviews or focus groups. Colaizzi's steps for data analysis were used to identify themes within the context of nursing.
Three major themes consisted of (a) barriers to optimal care, (b) internal conflict, and (c) coping. Barriers to optimal care reflected nurses lack of involvement in the plan of care; differences in focus between medicine and nursing practice models; disagreement among physicians and other health care team members; concerns about futile care and unnecessary suffering; dealing with unrealistic expectations of the family; and the lack of experience and education of the nurse to deal with terminal care provision. Internal conflict revealed feelings of relief when care goals shifted from curative to palliative at the end of life: and a desire for patient comfort and good memories for family; a sense of abandonment and powerlessness on the part of nurses; difficulty with medication administration; and difficulty in dealing with the death of younger patients. Coping reflected the positive and sometimes negative strategies that nurses used to manage terminal care. Strategies included building trust in order to communicate and educate the family, crying; using humor; talking to others about terminal care; avoiding care for terminal patients; and developing a “crusty” nurse attitude. Providing terminal care creates significant personal and professional struggles among ICU nurses.